Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA, USA.
J Am Coll Surg. 2010 Aug;211(2):256-62. doi: 10.1016/j.jamcollsurg.2010.03.011.
Obesity is strongly associated with endometrial and breast cancers; further, obese women are less likely to undergo recommended cancer screening. The objective was to determine the preoperative practices of bariatric surgeons with regard to gynecologic assessment and cancer screening.
A 28-question survey was mailed to 1,503 US bariatric surgeons to assess self-reported perceptions of gynecologic cancer screening, preoperative evaluation of female patients, and gynecologic oncology awareness and knowledge.
Of 1,503 surgeons, 274 responded (18%) and 11 incomplete surveys were excluded, leaving 263 (17%) for analysis. Mean surgeon age was 46.8 years. Surgeons averaged 13.9 years postresidency and were predominantly male (89%). Eighty percent obtained gynecologic histories, but 56% and 49%, respectively, did not require Pap tests or mammograms before bariatric surgery. Only 21% had ever referred a patient for endometrial evaluation. Female surgeons were more likely to obtain menstrual and cancer-related family histories (p < 0.05). Surgeons who graduated from residency 10 or more years ago were more likely to obtain a pregnancy history (p = 0.006). One-fifth of surgeons reported that they do not consistently counsel their patients about increased cancer risks due to obesity. Last, surgeons correctly identified the following signs and risk factors of endometrial cancer at variable rates: postmenopausal bleeding (99%), obesity (97%), irregular or heavy periods (69%), hereditary nonpolyposis colorectal cancer (21%), infertility (20.2%), diabetes (14.1%), and hypertension (4.9%).
Given the massive increases in morbid obesity and bariatric surgery in women, surgeons could serve a vital role in educating patients about both gynecologic and nongynecologic malignancy risks. With appropriate referral for cancer screening, patient outcomes could improve.
肥胖与子宫内膜癌和乳腺癌密切相关；此外，肥胖女性进行推荐癌症筛查的可能性较低。目的是确定肥胖症外科医生在妇科评估和癌症筛查方面的术前实践。
向 1503 名美国肥胖症外科医生邮寄了一份 28 个问题的调查，以评估他们对妇科癌症筛查、女性患者术前评估以及妇科肿瘤学意识和知识的自我报告看法。
在 1503 名外科医生中，有 274 名（18%）做出了回应，11 份不完整的调查被排除在外，留下 263 份（17%）进行分析。外科医生的平均年龄为 46.8 岁。外科医生平均在住院医师培训后工作了 13.9 年，主要是男性（89%）。80%的医生获取了妇科病史，但分别有 56%和 49%的医生在进行肥胖症手术前不需要进行巴氏涂片检查或乳房 X 光检查。只有 21%的医生曾经转介过子宫内膜评估的患者。女性外科医生更有可能获取月经和癌症相关家族史（p < 0.05）。从住院医师培训毕业 10 年或以上的外科医生更有可能获取妊娠史（p = 0.006）。五分之一的外科医生报告说，他们不会一直向患者提供有关肥胖导致癌症风险增加的咨询。最后，外科医生以不同的比例正确识别了子宫内膜癌的以下体征和危险因素：绝经后出血（99%）、肥胖（97%）、不规则或大量出血（69%）、遗传性非息肉病结直肠癌（21%）、不孕（20.2%）、糖尿病（14.1%）和高血压（4.9%）。
鉴于病态肥胖症和女性肥胖症手术的大量增加，外科医生可以在教育患者了解妇科和非妇科恶性肿瘤风险方面发挥重要作用。通过适当的癌症筛查转诊，患者的预后可以得到改善。
